Dosage adjustment

• Mild hepatic impairment• Concurrent use of ciprofloxacin and other CYP1A2 inhibitors

Contraindications

• Within 14 days of other MAO inhibitors or meperidine• Concurrent use with cyclobenzaprine, dextromethorphan, methadone, propoxyphene, tramadol, and St. John's wort

Precautions

Use cautiously in:• mild hepatic impairment (use not recommended in moderate or severe hepatic impairment), melanoma• concurrent use of levodopa, antidepressants, or CYP1A2 inhibitors (such as ciprofloxacin)• pregnant or breastfeeding patients• children (safety and efficacy not established).

Patient monitoring

☞ Stay alert for hypertensive crisis in patients using concurrent drugs that may cause this serious interaction.• Be alert for dopaminergic adverse effects and exacerbation of preexisting dyskinesias when rasagiline is used as adjunct to levodopa. Levodopa dosage may need to be reduced.• Monitor for orthostatic hypotension during first 2 months of therapy, especially when drug is used as adjunct to levodopa.• Inspect patient frequently for signs of melanoma.• In patient with hepatic insufficiency, obtain periodic liver function tests.

☞ Instruct patient to immediately report skin changes.• Tell patient drug may cause blood pressure to drop if he stands or sits up suddenly. Advise him to rise slowly and carefully.• Instruct patient to report hallucinations promptly.• Caution patient to avoid hazardous activities until he knows how drug affects concentration and alertness.• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

Gastrointestinal

Genitourinary

Dermatologic

Endocrinologic

Hematologic

Musculoskeletal

arthralgia

arthritis

neck pain

Neurologic

dyskinesia (may ↑ levodopa-induced dyskinesia)

paresthesia

Miscellaneous

allergic reactions

flu-like syndrome

↑ fall risk

fever

Interactions

Drug-Drug interaction

Ciprofloxacin and other inhibitors of the CYP1A2 enzyme ↑ rasagiline levels; dose adjustment is recommended.Meperidine has resulted in life-threatening reactions when used with other MAO inhibitors; wait at least 14 days after discontinuation of rasagiline to initiate meperidine.Similar reactions may occur with tramadol, methadone ; concurrent use should be avoided.Concurrent use with dextromethorphan may result in psychosis/bizarre behavior and should be avoided.↑ risk of adverse reactions with mirtazapine and cyclobenzapine ; concurrent use should be avoided.Hypertensive crisis may occur with sympathomimetic amines including amphetamines, cold products, and some weight loss products containing vasoconstrictors such as pseudoephedrine, phenylephrine, or ephedrine ; avoid concurrent use.↑ risk of serotonin syndrome with tricyclic antidepressants, SSRI antidepressants, SNRI antidepressants, and other MAO inhibitors ; rasagiline should be discontinued ≥14 days prior to initiation of antidepressants (fluoxetine should be discontinued ≥5 wk prior to rasagiline therapy).Hypertensive crisis may also occur when rasagiline is used with other MAO inhibitors ; allow at least 14 days between usage.Risk of toxicity is ↑ with St. John's wort.Ingestion of foods containing high amounts of tyramine (>150 mg) (e.g., cheese) may result in life-threatening hypertensive crisis.

Concurrent ingestion of tyramine-rich foods and many medications may result in a life-threatening hypertensive crisis. Signs and symptoms of hypertensive crisis include chest pain, tachycardia or bradycardia, severe headache, neck stiffness or soreness, nausea and vomiting, sweating, photosensitivity, and enlarged pupils.

Potential Nursing Diagnoses

Implementation

If used in combination with levodopa, a reduction in levodopa dose may be considered based on individual results.

Oral: Administer once daily.

Patient/Family Teaching

Instruct patient to take rasagiline as directed. Missed doses should be omitted and next dose taken at usual time the following day. Do not double doses. Do not discontinue abruptly; may cause elevated temperature, muscular rigidity, altered consciousness, and autonomic instability.

Caution patient to avoid alcohol, CNS depressants, and foods or beverages containing tyramine (see ) during and for at least 2 wk after therapy has been discontinued; they may precipitate a hypertensive crisis. Contact health care professional immediately if symptoms of hypertensive crisis or serotonin syndrome develop.

Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications. Caution patient to avoid use of St. John's wort and analgesics meperidine, tramadol, or methadone during therapy.

Caution patient to avoid elective surgery requiring general anesthesia, cocaine, or local anesthesia containing sympathomimetic vasoconstrictors within 14 days of discontinuing rasagiline. If surgery is necessary sooner, benzodiazepines, rapacuronium, fentanyl, morphine, and codeine may be used cautiously.

May cause dizziness or drowsiness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.

Caution patient to change positions slowly to minimize orthostatic hypotension. Geriatric patients are at increased risk for this side effect.

Advise patient to monitor for melanomas frequently and on a regular basis.

Caution patient to notify health care professional if new or increased gambling, sexual, or other intense urges occur.

London, Sept 24 (ANI): Scientists from Mount Sinai School of Medicine have found that drug rasagiline not only helps treat the symptoms of Parkinson's Disease, but also slows the rate of disease progression.

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